Autopsy radiography: digital radiographs (DR) vs multidetector computed tomography (MDCT) in high-velocity gunshot-wound victims

This study compared full-body digital radiography (DR) with multidetector computed tomography (MDCT) in the postmortem evaluation of gunshot wound (GSW) victims. Thirteen consecutive male GSW victims (mean age, 27 years) had full-body DR and MDCT prior to routine autopsy. DR successfully identified all metallic fragments, but MDCT was superior in its ability to precisely determine location because it provided 3-dimensional anatomic localization. In all cases, MDCT more accurately assessed organ injuries and wound tracks. Both DR and MDCT are limited in classifying multiple wounds and major vessel injury, but MDCT is generally superior to DR. MDCT shows significant advantages over DR in the forensic evaluation of GSW victims. This is particularly advantageous for the pathologist retrieving metallic fragments and for describing fracture detail accurately. Use of MDCT instead of radiographs will require medical examiners to become familiar with reading cross-sectional images.     

Gunshot entrance wound abrasion ring width as a function of projectile diameter and velocity

The relationships between gunshot entrance wound abrasion ring widths versus projectile diameter and velocity, using foam-backed deer hides as targets, were investigated. At a fixed velocity, abrasion ring width increased with increasing projectile diameter but decreased in proportion to the central defect diameter. For fixed-diameter projectiles, very slow and high velocities produced minimal abrasion width. Maximal abrasion width occurred at intermediate velocities. The authors postulate that abrasion width is a function of the ratio of projectile velocity and the maximum deformation velocity of the target skin. The largest abrasion width occurs when the ratio is one. Using a projectile velocity known to produce maximum abrasion width at an initial warm temperature, then decreasing the target deformation velocity by cooling, produced the expected results of decreasing abrasion width.     

Ballistic impact of hollow-point ammunition on porcine bone

Identifying failure mechanisms in skeletal tissue allows a deeper understanding of the effects of specific projectile impacts on bone. While ballistic trauma in flat bones is largely researched, knowledge of how long bones react to gunshot impacts is limited in the literature. The impacts of deforming ammunition appear to produce higher levels of fragmentation; however, these have not been studied in depth. This study compares the damage to femora bone by HP 0.357 and 9 mm projectiles constructed with both full and semi-metal jackets. Impact experiments were undertaken on a single-stage light gas gun involving the use of a high-speed video camera and full reconstruction of the bones to ascertain fracture patterns occurring in the femora. Higher degrees of fragmentation are likened to the presence of semi-jacketed HP projectiles than jacketed HP projectiles. The observations of external facing beveled edges are believed to be associated with the increased separation of the jacket and lead core of projectiles. Additionally, experimentation has shown that the amount of kinetic energy lost postimpact is likely related to the presence or the absence of a metal jacket on an HP projectile. The observed data, therefore, suggest that the composition, rather than the configuration, of a projectile affects the type and extent of the damage.     

Postmortem Computed Tomography and Magnetic Resonance Imaging of Gunshot Wounds to the Neck

Postmortem magnetic resonance imaging (MRI) is rarely used for the radiologic assessment of gunshot injuries, although it has clear advantages over postmortem computed tomography (CT) with regard to the imaging of soft tissue injuries. Another benefit in using MRI is that lodged projectiles composed of nonferromagnetic material such as lead present only marginal metal artifacts compared with severe artifacts on CT. This case report presents CT and MRI findings in a case with two gunshot wounds to the neck: a perforating wound and a nonperforating wound with a lead bullet lodged in the cervical spine. The decedent underwent CT and MRI before the scheduled autopsy. A ring of radiopaque material under the dermis in the fatty tissue was identified at both entrance wounds on CT, which was indicative of contact shots. The perforating gunshot was clearly indicated on CT by bullet fragments along the wound channel through the perforated 6th cervical vertebra and the fractured cricoid cartilage at the exit wound. The second trajectory, however, was only assumed based on the presence of gunshot residues at the entrance wound and the position of the lodged bullet. The radiologic assessment was severely impeded by the metal artifacts on CT. Barely noticeable metal artifacts on MRI allowed for clear visualization of the soft tissue injuries and the ruptured medulla oblongata. Only MRI clarified the soft tissue injuries of the brainstem noninvasively, which could provide specific and graphic information on the rapidity of death and the incapacitation of the victim.     

Scanning Electron Microscope Analysis of Gunshot Defects to Bone: An Underutilized Source of Information on Ballistic Trauma

Recent years have seen increasing involvement by forensic anthropologists in the interpretation of skeletal trauma. With regard to ballistic injuries, there is now a large literature detailing gross features of such trauma; however, less attention has been given to microscopic characteristics. This article presents analysis of experimentally induced gunshot trauma in animal bone (Bos taurus scapulae) using full metal jacket (FMJ), soft point (SP), and captive bolt projectiles. The results were examined using scanning electron microscopy (SEM). Additional analysis was conducted on a purported parietal gunshot lesion in a human cranial specimen. A range of features was observed in these samples suggesting that fibrolamellar bone response to projectile impact is analogous to that observed in synthetic composite laminates. The results indicate that direction of bullet travel can be discerned microscopically even when it is ambiguous on gross examination. It was also possible to distinguish SP from FMJ lesions. SEM analysis is therefore recommended as a previously underexploited tool in the analysis of ballistic trauma.     

Contribution of Antemortem Computed Tomography Findings to Cause of Death Determination: An Unusual Fatal Stroke

In the case reported here, the antemortem computed tomography scan (CT scan) was essential in the forensic investigation. A 32‐year‐old man was found fully awake with a facial abrasion, after what seemed to be a car accident. He lost consciousness suddenly one hour after initial management. Successive CT scan showed a facial fracture and a metallic foreign body in the carotid canal associated with an occlusion/dissection of the left internal carotid, a pseudoaneurysm, and a carotid‐cavernous fistula. The victim died from a stroke. Autopsy confirmed that the facial abrasion was a gunshot entrance wound, the metallic foreign body being a projectile. Intracranial vascular injuries linked with gunshot wounds are most of the time isolated and due to pelet embolism. The observed vascular injury association has never been described in the existing literature. The CT scan provided a better understanding of the chronology of events that led to death.     

Recovery and evaluation by cytologic techniques of trace material retained on bullets

Fragments of tissue, intermediate targets, and debris related to firing are embedded in the fine striations and deforming edges of bullets. Because most of these fragments are too small to visualize and process as histologic sections, this material is usually washed away when the projectiles are cleaned following removal at autopsy. By preserving the rinsing material that results from routine cleaning of projectiles, it may be possible to evaluate adherent material from the bullet by cytologic techniques, including filter preparations, cell blocks, and smears of macroscopic tissue fragments. Bullet-wash cytology produced cellular elements, tissue fragments, and inert material from intermediate targets. Different tissue elements could be documented with a given projectile; this information could be utilized to document the path of a bullet through the body or intermediate target. This initial study suggests that low- and high-velocity projectiles produce different types of tissue debris, with much more fragmentation and scarcity of cellular components in the high-velocity rounds. Inert material, resulting from intermediate targets, such as clothing, as well as gunshot residue on the bullet or debris from the barrel could be distinguished on preparations. There was a difference in tissue representation of adherent material on the bullet; connective tissue, mesothelial coverings, and fragments from organs with higher elastic and cohesive properties were seen with much greater frequency on the filters than were loosely cohesive and friable organs such as liver and spleen. The cytologic preparations from projectile washings reflect both the path taken by the bullet and the ballistic damage to the organs. Thus, the cytologic evaluation of bullet washings may be useful in the incorporation of gunshot wound evaluation to support documentation of the trajectory of the projectile.     

The hydrodynamic effect of gunshots in cranial explosive shots

Case report on five fatal gunshot injuries in which discharge of the cranial contents had occurred owing to a skull blast. Despite an appreciable explosive action with destruction of the bony cranium, the brains were not completely destroyed. In analogy to the "Kr?nlein shot", comparative reflections were made concerning wound ballistics. The case reports show that injury patterns resembling "Kr?nlein shot" may arise in cranial blast shots in rare cases despite destroyed projectile parts and even in a mouth shot.     

A first time for everything: homicide involving the Brenneke SuperSabot shotgun slug

Sabot shotgun slugs are not a new projectile, but the Brenneke SuperSabot shotgun slug has never been reported in a homicide. We present the case of a 28-year-old man killed with multiple gunshot wounds during an alleged "drive-by" shooting. At autopsy, a 496.2 grain slightly deformed projectile with a base diameter of 5/8' (1.7 cm) was found within the decedent's clothing. Six distinct bullet tracks were identified. An entrance of the anterior right thigh was 3/4 x 5/8' and ovoid, having only passed through the decedent's jeans. This bullet track passed through the soft tissue of the right thigh, exiting out the medial aspect and partially transecting the right greater saphenous vein, re-entering the medial left thigh and re-exiting out the posterior left upper thigh. With the exception of an irregular entrance on the sole of the left foot, which passed through the decedent's shoe, all other entrances were less than 1/2' in greatest dimension. Investigating officers recovered an additional projectile of the same type, which had undergone more extensive deformation after striking and penetrating the tailgate of a truck. Further investigation identified the projectiles as the Brenneke SuperSabot shotgun slugs.     

Case Report of a Migrating Bullet: An Unusual Cause of Postmortem Confusion

Migrating bullets are rare sequelae of penetrating gunshot wounds. Such cases have been described in the neurosurgical literature because they can produce complications in the management of patients such as decline in neurologic status, delays in rehabilitation, and difficulties in bullet removal. In contrast, few postmortem reports have described this phenomenon. We report a case of a gunshot wound in which the projectile entered the left side of the head and traversed to the right frontal area as documented by CT scan on hospital admission. At autopsy, the bullet was noted to have migrated back to the left side of the head from where it was recovered. Medical examiners need to be aware of this unusual phenomenon of retained intracranial projectiles.     

Experimental study of the expansion dynamic of 9 mm Parabellum hollow point projectiles in ballistic gelatin

We study in this paper the expanding behaviour of hollow point 9 mm Parabellum projectiles (Hornady XTP(?) and Speer Gold Dot(?)). We defined a deformation rate that takes into account both the diameter increase and the length reduction. We plotted the behaviour of this parameter versus impact velocity (we refer to this curve as the expanding law). This expanding law has been plotted for different gelatin weight ratios and different gelatin block lengths. We completed our experiments with a set of high speed movies in order to correlate the deceleration to the state of expansion and size of the temporary cavity. Our results pointed out that full expansion is reached shortly after the projectile fully penetrates the gelatin. This result shows that the key point to accurately simulate human body interaction with a hollow point projectile is to accurately simulate the interface (skin, skull, clothes thoracic walls). Simulating accurately organs is only an issue if a quantitative comparison between penetration depths is required, but not if we only focus on the state of expansion of the projectile. By varying the gelatin parameters, we discovered that the expanding law exhibits a velocity threshold below which no expansion occurs, followed by a rather linear curve. The parameters of that expanding law (velocity threshold and line slope) vary with the gelatin parameters, but our quantitative results demonstrate that these parameters are not extremely critical. Finally, our experiments demonstrate that the knowledge of the expansion law can be a useful tool to investigate a gunshot in a human body with a semi-jacketed projectile, giving an estimation of the impact velocity and thus the shooting distance.     

Anthropological Measurement of the Juvenile Clavicle Using Multi‐Detector Computed Tomography—Affirming Reliability

Currently, there is no standardized protocol for multi‐detector computed tomography (MDCT) measurement of juvenile remains. Using 33 juvenile clavicles, this paper investigates a protocol to allow MDCT measurements, comparable or supplemental with traditional osteometric measurements, to be acquired for application to previously published algorithms. The results illustrate that there is no significant difference between MDCT measurements and those taken by direct osteometric methods. By presenting such a protocol, this paper takes the first steps toward validation of the process of conversion from measurement of dry juvenile bone to MDCT compatibility and allows the forensic world to take a step forward in standardizing the way MDCT is used for forensic practice. This paper assesses the limitations and potential applications of this virtual approach and offers some suggestions for where further work might progress the conversion of these new approaches into legally admissible anthropological techniques of age estimation.     

Forensic medical expert evaluation of gunshot injuries of brain skull

Forensic medical experts are offered a set of morphological signs which help identify the gunshot origin of a skull injury, identify which of the injuries is the inlet and which is the outlet, specify the direction of the shot and succession of formation of injuries in cases with several shots. The author suggests evaluating a gunshot wound in the head with due consideration for the mechanisms of its formation. From a complex of signs of a gunshot injury to the brain skull he singles out the tissue defect with a conical channel and the edge of bone defect, additional injury to the external compact plate near the inlet, and type, number, and location of the radial and concentric cracks. Analysis of the morphology of the above listed signs of gunshot injuries to the skull notable extends the potentialities of forensic medical expert evaluation in cases with gunshot injuries.     

A study of the morphology of gunshot entrance wounds, in connection with their dynamic creation, utilizing the "skin-skull-brain model"

The goal of this study was to document the dynamic effects created within, and the developing mechanisms of a gunshot entrance wound to the skin utilizing high-speed photography and the "skin-skull-brain model". The high-speed photography was taken with an Imacon 468/Hadland-Photonics camera. Full metal jacketed, 9 mm Luger projectiles were fired at the target model from a distance of 10 m. During the evaluation of the "skin-skull-brain model", it was possible to show that injuries inflicted to this model are fully comparable to the morphology of equivalent real gunshot entrance wounds. It has been possible to document and study the dynamic process of the "bullet-skin-interaction" in the gunshot entrance wound. The development of the morphologic terms of the entrance wound are discussed. In combination with high-speed photography, this "skin-skull-brain model" is a perfect tool for the documentation and the study of the dynamic development of gunshot entrance wounds in the skin.     

Brain injury after survived gunshot to the head: reactive alterations at sites remote from the missile track

Gunshot wounds to the brain usually lead to acute respiratory arrest or death after a brief survival period, even in cases involving only slight direct tissue damage. It can be assumed therefore that the damage extends beyond the zone of recognizable destruction and hemorrhages. To determine the true extent of the tissue injury resulting from gunshot wounds to the brain, we carried out microscopic investigations for reactive changes (emigration of leukocytes and macrophages, axonal expression of beta-amyloid precursor protein (beta-APP) in 10 cases of gunshot wound to the narrow channel of the brain with survival times >2h. Demonstration of leukocytes expressing naphthol AS-D chloroacetate esterase activity in the brain tissue at the border of the missile track established the vitality of the gunshot effect. The presence of macrophages (CD68-epitope) allowed demarcation of a 1-2mm wide necrotic zone around the permanent cavity. Within this zone and beyond, beta-APP showed an initial increase followed by a decline in the number of injured axons. Three types of beta-APP positive staining could be differentiated. In the immediate vicinity of the missile track beta-APP positive neurons were present at a distance of 2-4mm from the margin of the permanent cavity (type 1) as a result of primary injured neuronal tissue by the gunshot itself. At longer distances from the narrow channel and the permanent cavity single beta-APP positive axons or axon fragments and two additional types were found; type 2 shows a parallel, wave-like arrangement of the damaged fibers, which suggests that the injury was produced by mechanical acceleration of the brain tissue created by the energy the projectile expended within the brain; irregular aggregation of beta-APP positive axons or axon fragments within a local edema represents type 3, which may be attributed to secondary ischemia or edema.     

Cone‐beam Computed Tomography for Analyzing Variations in Inferior Alveolar Canal Location in Adults in Relation to Age and Sex*

Abstract: Previous studies have indicated that the relative position of the inferior alveolar canal and its mental and mandibular foramina in adults vary with age and show sexual dimorphism. Conceivably, these purported differences could be of forensic value for determining identity of human remains. This study was designed to determine the influence of age and sex on the relative position of inferior alveolar canal and its foramina in cone‐beam computed tomography (CBCT) studies of adults. Existing CBCT studies of the maxillofacial region from dentate adult patients selected at random and ranging in age from 18 to 80 years (110 women and 55 men) were acquired, and the location of the inferior alveolar canal was assessed at three points: the mandibular foramen in axial view, the inferior alveolar canal in coronal view, and the mental foramen in coronal view. Measurements were also expressed for the mental foramen as the percentile position from the nearest superior bony crest to the inferior border; corresponding position of the mandibular foramen from the anterior to the posterior border of the mandibular ramus; and for the inferior alveolar canal at the level of first permanent molar from the nearest buccal bony surface to the lingual surface and from the superior alveolar crest to the inferior border. Regression analyses were performed on the variables with regard to the effects of age and sex. Most analyses resulted in no statistical significance (p < 0.05). A few of the sex‐specific traits demonstrated near‐statistically significant effects; however, these characterizations generally resulted in a 1% or less change per age decade. Overall, the results demonstrated that the relative location of the inferior alveolar canal and associated foramina in adults remain fairly constant without regard to age and sex.     

Prediction of Projectile Ricochet Behavior After Water Impact*

Abstract: Although not very common, forensic investigation related to projectile ricochet on water can be required when undesirable collateral damage occurs. Predicting the ricochet behavior of a projectile is challenging owing to numerous parameters involved: impact velocity, incident angle, projectile stability, angular velocity, etc. Ricochet characteristics of different projectiles (K50 BMG, 0.5‐cal Ball M2, 0.5‐cal AP‐T C44, 7.62‐mm Ball C21, and 5.56‐mm Ball C77) were studied in a pool. The results are presented to assess projectile velocity after ricochet, ricochet angle, and projectile azimuth angle based on impact velocity or incident angle for each projectile type. The azimuth ranges show the highest variability at low postricochet velocity. The critical ricochet angles were ranging from 15 to 30°. The average ricochet angles for all projectiles were pretty close for all projectiles at 2.5 and 10° incident angles for the range of velocities studied.     

Comparison of gunshot wounds and field-tipped arrow wounds using morphological criteria and chemical spot tests

Arrow wounds represent an unusual class of wounds rarely seen by most death investigators. Although the edged, broadhead-tipped arrow produces a wound usually characteristic of archery/crossbow weapons, the plain, field-tipped arrow wound can be confused with gunshot injuries in those cases in which powder residue or firearm projectiles or fragments or both are not recovered. We present a case of a deer carcass with a wound of uncertain firearm or archery origin which initiated a comparison of firearm wounds and archery wounds on fresh road-killed deer. We found the following features to be valuable in the differentiation of gunshot wounds and field-tipped archery wounds: First, the majority of the gunshot wounds (but none of the arrow wounds) had identifiable, macroscopic, wipe-off material and chemically identifiable wipe-off residue by spot test. Second, the archery wound defects had very inconspicuous abrasion rings as compared to the often prominent abrasion rings of gunshot wounds. Third, the actual central defect in the archery wounds was more likely to be oblong or slit-like compared to the gunshot wound defects, which were more likely to be round.